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The impact of external factors on psoriasis. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Psoriasis is one of the most common chronic inflammatory skin diseases, constituting a significant health and socioeconomic problem. Despite numerous therapeutic options, the results of treatment very often remain insufficient. It is extremely important to remember that many external factors impact the effectiveness of therapy. This article discusses the importance of emollients in therapy and the influence of infectious agents and injuries on the course of psoriasis. Understanding the above-mentioned factors in the treatment of psoriasis is critical to achieve satisfactory therapeutic effects.
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Heetfeld AB, Schill T, Schröder SS, Forkel S, Mahler V, Pfützner W, Schön MP, Geier J, Buhl T. Challenging a paradigm: skin sensitivity to sodium lauryl sulfate is independent of atopic diathesis. Br J Dermatol 2019; 183:139-145. [PMID: 31562780 DOI: 10.1111/bjd.18564] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Sodium lauryl sulfate (SLS) is the best-studied detergent in irritant contact dermatitis. In atopic dermatitis, the two major pathophysiological abnormalities concern skin barrier function and regulation of cutaneous immune responses. The probability of atopic skin diathesis can be assessed by comprehensive analysis of patient history, as well as clinical and laboratory findings, resulting in the Erlangen Atopy Score (EAS). OBJECTIVES To investigate the impacts of (i) atopic skin diathesis according to the EAS and (ii) the physician-assessed diagnoses 'atopic dermatitis', 'allergic rhinitis' and 'allergic asthma' on SLS skin reactions. METHODS This is a retrospective analysis of data from 2030 consecutive patients patch tested with SLS (0·25% aqueous) from two tertiary referral centres in Germany, from 2008 to 2014. RESULTS Patients with a high probability of atopic skin diathesis showed no significant increase in positive SLS reactions compared with patients without atopic skin diathesis (14·2% vs. 16·8%). The grading of positive SLS skin reactions (1-4) revealed no differences in patients with or without atopic skin diathesis. Furthermore, diagnoses of atopic dermatitis, allergic rhinitis or allergic asthma had no impact on positive SLS skin reactions in multivariate logistic regression analysis. CONCLUSIONS We found no association of increased skin irritability to SLS with atopic skin diathesis, atopic dermatitis, allergic rhinitis or allergic asthma in a large patient cohort. It therefore seems that the test of skin irritability with SLS, which is currently common practice in many centres, does not allow prediction of susceptibility to irritant eczematous inflammation in atopic vs. nonatopic individuals. What's already known about this topic? Irritant contact dermatitis and atopic skin diathesis share impaired skin barrier function as a pathophysiological pattern. Sodium lauryl sulfate (SLS) is tested at 0·25% aqueous as an irritant control in patch testing, and hence the results might be affected by atopic skin diathesis. What does this study add? Challenging a long-standing paradigm, we found no association of increased reactivity to SLS patch tests in individuals with atopic skin diathesis, atopic dermatitis, allergic rhinitis or allergic asthma in a large patient cohort. Thus, irritant control testing with SLS, which is useful in interpreting doubtful allergen patch test results, does not depend on individual atopy status.
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Affiliation(s)
- A B Heetfeld
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany
| | - T Schill
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany
| | - S S Schröder
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany
| | - S Forkel
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany
| | - V Mahler
- Paul-Ehrlich-Institut, Langen, Germany.,Department of Dermatology and Allergology, University Medical Center Erlangen, Erlangen, Germany
| | - W Pfützner
- Department of Dermatology and Allergology, Allergy Center Hessen, University Medical Center Marburg, Marburg, Germany
| | - M P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany
| | - J Geier
- Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany.,Information Network of Departments of Dermatology (IVDK), University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany
| | - T Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Germany
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Moldovan HR, Voidazan ST, John SM, Weinert P, Moldovan G, Vlasiu MA, Szasz ZA, Tiplica GS, Szasz S, Marin AC, Salavastru CM. The Eastern European experience on occupational skin diseases. Make underreporting an issue? J Eur Acad Dermatol Venereol 2018; 31 Suppl 4:5-11. [PMID: 28656727 DOI: 10.1111/jdv.14315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND While legislation in most of the Eastern European countries is nowadays widely harmonized with the legal safety and health provisions of Western countries, there is still a sustained resistance to the notification of occupational skin diseases (OSD). OBJECTIVE The aim of the study was to identify the main barriers in notification and recognition of OSD in 22 Eastern European countries. METHODS An online survey was administered to key persons in the field of occupational safety and health in 22 Eastern European countries. Multiple variables of the notification system were studied, including clinical, organizational and educational issues. RESULTS The main causes of underreporting OSD are ineffective enforcement of occupational safety and health legislation, contractual relationship employer-employee, long duration of the notifying process, restrictions of the notification systems in terms of who is entitled to notify an OSD, ineffective regulations in regards to the pre-employment and periodical medical examination, ineffective compensation schemes, restraints and hesitations, mainly from the doctors, inappropriate mentalities - fear of losing the jobs, fining of the employers by the authorities, stigmatization of the workers with OSD, additional costs for employers, stakeholders' lack of interest in notifying, lack of guidelines and protocols and lack of preventive programmes. CONCLUSIONS The most valuable method for a proper recognition of OSD is to increase the awareness of physicians involved in the management of OSD (occupational physicians, GPs, dermatologists), as well as employers and workers. There is an urgent need to improve national legislation, to develop and promote adequate preventive programmes, emphasizing ethical, legal, economical and psychological aspects in order to achieve an increased recognition and a real reporting of OSD, and to enforce an international action plan for Eastern Europe in order to improve the notification of OSD.
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Affiliation(s)
- H R Moldovan
- University of Medicine and Pharmacy of Tirgu-Mures, Tirgu-Mures, Romania
| | - S T Voidazan
- University of Medicine and Pharmacy of Tirgu-Mures, Tirgu-Mures, Romania
| | - S M John
- Department of Dermatology and Environmental Medicine, University of Osnabrueck, Osnabrueck, Germany.,Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrueck, Germany
| | - P Weinert
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrueck, Germany
| | - G Moldovan
- Mediconsult Medical Centre, Tirgu-Mures, Romania
| | - M A Vlasiu
- Mures County Clinical Hospital, Tirgu-Mures, Romania
| | - Z A Szasz
- University of Medicine and Pharmacy of Tirgu-Mures, Tirgu-Mures, Romania
| | - G S Tiplica
- Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - S Szasz
- University of Medicine and Pharmacy of Tirgu-Mures, Tirgu-Mures, Romania
| | - A C Marin
- University of Medicine and Pharmacy of Tirgu-Mures, Tirgu-Mures, Romania
| | - C M Salavastru
- Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
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Abstract
BACKGROUND Health care of patients with occupational dermatitis (OD) in the sense of suspected "BK 5101" is carried out in Germany within the optimized dermatologist's procedure and the "dermal intervention" (formerly: hierarchical multistep intervention approach) of the statutory accident insurance (UVT), respectively. OBJECTIVES AND METHODS Dermatologists and UVT administrators are obliged to improve OD patient care by continuous quality management measures. Essential quality management elements include the research projects EVA_Haut and VVH, the clearing procedure of the Task Force on Occupational and Environmental Dermatology (ABD), training of dermatologists to receive the CME certificate "Occupational Dermatology (ABD)", the establishment of processing standards for administrators and optimized dermatologist's report forms (based on the results of all the above steps taken). RESULTS It was shown that the optimized dermatologist's procedure and "dermal intervention" are established in Germany. Also, the available preventive and therapeutic measures for OD patients are effective. Despite the increase of cases with suspected OD, the number of cases in which a career change was required is almost constant (3 %); at the same time the percentage of notified cases which, as a result, are covered within the dermatologist's procedure by the UVT is rising (86 %). The measures recently taken have continuously increased quality of health care in occupational dermatology.
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Affiliation(s)
- H Voß
- Fachgebiet Dermatologie, Umweltmedizin, Gesundheitstheorie, Universität Osnabrück, Sedanstr. 115 (Station D1), 49090, Osnabrück, Deutschland,
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